1. Introduction to Medical Imaging Mammography and Computer Aided Diagnostic (CAD) Example Guy Gilboa Course 046831

2. Mammography

3. Mammography purpose Mammography is the process of using low-energy X-rays (usually around 30 kVp) to examine the human breast, which is used as a diagnostic and screening tool. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses and/or microcalcifications.

4. Basic structure

5. Obtained images

6. Early detection is an effective way to diagnose and manage breast cancer. Computer-aided detection or diagnosis (CAD) systems can play a key role in the early detection of breast cancer and can reduce the death rate among women with breast cancer. (*) Based on the paper J. Tang et al. "Computer-aided detection and diagnosis of breast cancer with mammography: recent advances." Information Technology in Biomedicine, IEEE Transactions on 13.2 (2009): 236-251.

7. Example – aiding radiologists An original mammogram (left) and after MED-SEG processing (right), indicating a region of interest in white. Taken from http://www.laserfocusworld.com/blogs/photon-focus/2011/10.htmlhttp://www.laserfocusworld.com/blogs/photon-focus/2011/10.html

8. Need for CAD – early detection At present, there are no effective ways to prevent breast cancer, because its cause remains unknown. However, efficient diagnosis of breast cancer in its early stages can give a woman a better chance of full recovery. Therefore, early detection of breast cancer can play an important role in reducing the associated morbidity and mortality rates.

9. Need for CAD (cont’) Computer-aided detection or diagnosis (CAD) systems use computer technologies to detect abnormalities in mammograms. Abnormalities include calcifications, masses, and architectural distortion. The use of these results by radiologists for diagnosis can play a key role in the early detection of breast cancer and help to reduce the death rate among women with breast cancer.

10. Medical background - Microcalcifications (MC) MCs are tiny deposits of calcium that appear as small bright spots in mammograms. Clustered MCs can be an important indicator of breast cancer. They appear in 30%–50% of cases diagnosed by mammographic screenings

11. MC detection methods 4 broad categories: 1. Basic image enhancement. 2. Stochastic modeling. 3. Multiscale decomposition. 4. Machine learning methods.

12. Image enhancement Motivation: MCs tend to be brighter than their surroundings. Image enhancement methods are used to improve the contrast of MCs, and then apply a threshold to separate them from their surroundings. DenoisingThresholding Post-processing (e.g. morphological operators)

13. Stochastic Modeling Utilize statistical differences between MCs and their surroundings. For instance, Gurcan et al. used differences in higher order statistics [e.g., the third moment (skewness) and the fourth moment (kurtosis)], where it was conjectured that areas with no MCs would have a Gaussian-like distribution and areas with MCs would be non-Gaussian (nonzero skewness and kurtosis). This approach can be prone to errors in background (non- MC) regions that are spatially variant. Advanced methods today use Markov random field (MRF) and Gaussian mixture models. However, estimating a proper prior distribution remains a challenging task in these probabilistic approaches.

14. Multiscale Decomposition Exploits the differences in frequency content between MC spots and their surrounding background. In particular, wavelet transforms have been widely investigated for MC detection. For instance, Strickland and Hahn used undecimated biorthognal wavelet transforms in which MCs were represented by circular Gaussian shapes with varying widths along the different scales. The undecimated wavelet transform has the advantage of being translation invariant. Optimal subband weighting was applied prior to reconstruction from subbands 2 and 3 for improved detection and segmentation of clustered MCs. These methods are often used as feature extraction techniques that are used in conjunction with other approaches (e.g., as input to classifiers).

15. Machine Learning methods Aim to decipher dependencies from the data. In the context of MC detection, the problem is typically treated as a binary classification process, where the goal is to determine whether an MC is present or not at a pixel location. As an example, Yu and Guan proposed a two-stage neural network approach, where wavelet components, gray-level statistics, and shape features were used to train a two-stage network. ◦ The first stage identifies potential MC pixels in the mammograms. ◦ The second stage detects individual MC objects. Machine learning methods have received the largest share of research in recent developments. Machine-learning-based methods seemed to have achieved the best performance.

16. Example – using wavelets Jinghuan, Guo, et al. "Study on Microcalcification Detection Using Wavelet Singularity." International Journal of Signal Processing, Image Processing & Pattern Recognition 7.1 (2014).

17. MC detection summary Taken from (*)

18. Sensitivity-Specificity curves T=True; F=False; P=Positive; N=Negative Sensitivity – (true positive)/(total ill cases)=TP/(TP+FN) Specificity – (true negative)/(total well cases) = TN/(TN+FP)

19. CAD generic procedure Medical image

20. Other CAD examples - retina

21. Detection of colon polyps From http://www.med.nagoya-u.ac.jp/english01/6489/6600/Diagnostic-Medical-Image-Processing.htmlhttp://www.med.nagoya-u.ac.jp/english01/6489/6600/Diagnostic-Medical-Image-Processing.html

22. Cardiac – stenosis assessment The investigational CAD algorithm automatically tracks and segments the coronary tree, extracting vessel centerlines and labeling them before performing automated stenosis detection and marking of target vessels. From http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=90789http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=90789

23. Exam exercise Reminder FDG – a PET radiotracer Q.3 Moed A, Q.7 Moed A

24. What have we learnt in this course? The main modalities X-ray, CT, MRI, Ultrasound, PET: ◦ The basic physics behind them. ◦ The main medical applications. Image processing of medical data ◦ Tomography and reconstruction ◦ Denoising ◦ Segmentation ◦ Motion compensation and deconvolution ◦ Registration